NUR353- Complex Care Nuring Assignment
- Subject Code :
NUR353
You are completing your PEP (Professional Experience Placement) hours for NUR353 in the emergency room. This is your second shift in this department. You have received a new patient. The patient has just arrived at the unit. Ron is a 56-year-old male with a history of type 1 diabetes mellitus (DM) and hypertension. Ron has recently returned from a trip to Thailand 3 days ago. He has had a fever for 3 days and is complaining of diarrhea with nausea and vomiting. He has not been able to eat and has tolerated only sips of fluid. Because he could not eat, he did not take his insulin.
Ron is unsteady and was brought to the examination room in a wheelchair. While helping him to the bed, you notice that his skin is warm and flushed, and his breath is fruity and sweet smelling. Ron is drowsy and unable to answer your questions. His wife tells you that he has complained of being thirsty but has not been able to keep any water down. As you get Ron settled, the nurse you work with has taken urgent bloods (Biochemistry and FBC) and sent to pathology.
- List the abnormal cues from the above scenario. (2/60 marks)
- Identify other questions you want to ask him or his wife. (4/60 marks)
His wife tells you that the blood glucose monitor has been reading high, and Ron has only been able to have a few sips of ginger ale.
After they arrived home from the airport, Ron voided 'a lot' but hardly passed urine yesterday and has not used the toilet today.
Ron went to bed early yesterday, and she could hardly wake him up this morning, which is why she brought him in.
- Which cues might indicate diabetic ketoacidosis (DKA)? (4/60 marks)
- In relation to each cue, describe the pathophysiology of diabetic ketoacidosis (DKA). (8/60 marks)
- List 5 key goals of nursing care associated with DKA. (4/60 marks)
You take Ron's vital signs and document these on the chart.
- Blood pressure 90/50 mm Hg
- Heart rate 124 beats/min
- Respiratory rate 36 and deep
- Temperature 38.5 C (Tympanic)
- Are these vital signs within the normal range for a patient of Ron's age and medical history? If not, why not. Discuss your rationale. (8/60 marks)
Rons wife hands you his medication list. You note that Ron is prescribed:
- Diovan 80 mg po OD
- Prinivil 10 mg po OD
- Omeprazole 20 mg OD
- Lantus 18 units subcutaneous q AM
- Humalog 19 units subcutaneous TID before meals
- Explain the pharmacodynamics of the above medications. (6/60 marks)
As you document the vital signs, the nurse you work with tells you that Rons pathology results are as follows:
- Glucose 28 mm/L
- Potassium 5.8 mmol/L
- Explain the above values and describe the pathophysiology associated with these results. (4/60 marks)
After the doctor examines the patient, she suspects that Ron is in DKA and orders additional pathology. At this time, you go on your break. The nurse you are working with establishes intravenous therapy and completes medication orders.
When you return from your break. Rons wife asks you ‘how did this happen’?
She is worried about when Ron is discharged. How can DKA be prevented?
- You are required to formulate a plan of education for Ron's wife, so she will better understand his condition and be able to assist him to manage those days when is unwell.
What areas would you cover? How would you ascertain her understanding? (8/60 marks)
Your shift is over, and you provide handover to the oncoming nurse. See DAY TWO.
DAY TWO
You return to the emergency department the next day for the evening shift. You find that Ron is waiting to be transferred to the ICU because of a lack of beds. You assume care of Ron. Handover has been given. Ron has been stable during the night and has responded well to DKA management.
You review Ron’s chart before you enter the patient's room, and you notice the following pathology result:
- GFR 25 mL/min
- What does the above result indicate? (4/60 marks)
You enter Ron's room. Ron is asleep, and you can see that his wife has been crying. She explains that Ron has been diagnosed with Stage 4 chronic kidney disease and does not understand what this diagnosis means.
- Describe the disease process, prognosis, and treatment goals. (8/60 marks).
